Cereals and the Risk for Heart Failure:Is There a Link?

Abstract & Commentary

By Joseph Varon, MD, FACP, FCCP, FCCM, Clinical Professor of Medicine and Professor of Acute and Continuing Care at the University of Texas Health Science Center in Houston; Clinical Professor of Medicine at The University of Texas Medical Branch at Galveston. Dr. Varon reports no financial relationship to this field of study.

Synopsis: When whole grain cereal (WGC) is consumed regularly, there is a lower risk of developing heart failure (HF). This association is likely to be linked to the beneficial effects of WGC on risk factors (ie, hypertension, obesity, hyperlipidemia) rather than HF itself.

Source: Djoussé L, Gaziano M. Arch Intern Med. 2007;167: 2080-2085.

This prospective study was aimed atevaluating the effect of breakfast cereals on the development of HF using data from the Physicians' Health Study I (PHSI) in which 261,248 male physicians participated in 1981. In this study, more than 22,000 participants were randomized to receive a daily low-dose aspirin, beta-carotene, both agents or daily placebo. A total of 21,376 participants were enrolled in this trial that included specific information regarding the consumption of breakfast cereals. Self-reporting of the consumption was utilized using a survey instrument. The participants received a simple questionnaire every six months for the first year and every 12 months thereafter to obtain information regarding the occurrence of newly diagnosed HF. The total number of breakfast cereals was utilized as the main exposure. A stratified analysis followed to separate WGC from refined cereals.

The mean age at randomization was 53.7 ± 9.5 years. A higher number of elderly participants consumed breakfast cereals. The average follow up of participants was 19.8 years, during which 1018 new cases of HF were self reported. Fewer cases of HF were observed when breakfast cereal was consumed. The higher number of weekly servings also influenced the development of HF. When updated cereal consumptions was analyzed at 24, 48, 72, 96 and 120 months, an inverse association to HF was found. In further statistical analysis of the type of cereal consumed, these investigators found an inverse association between WGC and HF that was not found with refined cereals.

Commentary

This study showed a strong association between the consumption of WGC and the incidence of HF. Several studies have previously demonstrated beneficial effects of fiber consumption on hypertension, atherosclerotic cardiovascular disease and obesity.1,2 In a previous study, utilizing this same population, an inverse association between WGC consumption and cardiovascular mortality was found.3

The specific mechanism by which WGC are protective remain to be determined. However, these cereals contain potassium, which is known to lower blood pressure.4 In addition, they have antioxidant properties, and have an effect on lipid metabolism.5 With the findings of the present study, intervention studies should follow in attempts to prospectively diminish the incidence of HF.

References:

1. Pereira MA, et. al. Arch Intern Med. 2004;164:370-376.

2. Meyer KA, et al. Am J Clin Nutr. 2000;71:921-930.

3. Liu S, et al. Am J Clin Nutr. 2003;77:594-599.

4. Brancati FL, et al. Arch Intern Med. 1996;156;61-67.

5. Truswell AS. Eur J Clin Nutr. 2002;56:1-14.